Cdcr

NPI 1134558240 - Psychologist - 103T00000X

NPI Details
NPI 1134558240
Enumeration Date 11/08/2013
Last Updated 11/08/2013
Entity Type Healthcare Provider
Active Over 3 years ago
Authorized Information
Name KO BRUCE KO
Position PSYCHOLOGIST
Phone (209) 274-4911
Fax (209) 274-5147
Practice Location
4001 HIGHWAY 104
IONE CA, 95640, US
Phone (209) 274-4911
Fax (209) 274-5147
Business Location
5215 LOTUS POND WAY
ELK GROVE CA, 95757-4342, US
Phone (916) 296-5089
Fax
Toxanomy
Taxonomy Code 103T00000X
License State California
License Number PSY18841
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According to our database, Cdcr NPI is 1134558240, taxonomy code is 103T00000X and license number is PSY18841, license state is located at California. Cdcr physically located at 4001 Highway 104, Ione CA, 95640. NPI Number 1033115704 has the healthcare provider type.

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1134558240 NPI number is provided on an as is basis without warranty of any kind. 1134558240 is maintained by the National Plan & Provider Enumeration System. The contents of Cdcr are for informational purposes only.